Personal view or opinion piece
Open Access

Recommendations for Millennials on Successfully Navigating Medical Training

Asif Padiyath[1], Elijah Bolin[2], Joshua Daily[2]

Institution: 1. John Hopkins Hospital, 2. University of Arkansas for Medical Sciences
Corresponding Author: Dr Joshua Daily ([email protected])
Categories: Professionalism/Ethics, Students/Trainees, Teaching and Learning
Published Date: 27/06/2019

Abstract

Most current trainees in medicine are from the Millennial generation, and most attending physicians are either Baby Boomers or from Generation X. Specific generational differences among physicians have the potential to cause conflict and negatively impact patient care. The authors, who are millennial physicians, wrote this commentary to provide millennial trainees with insight into their own generational tendencies, and give recommendations on how to successfully navigate training.

Keywords: millennials; generation

Introduction

During my first year of cardiology fellowship, I (EB) distinctly remember lamenting with my co-fellows that we were underperforming, given the seemingly endless stream of criticism we received. We were surprised when, upon sharing our concerns with our fellowship program director, we were told that we were doing just fine. It was clear that my co-fellows and I thought about criticism very differently from our attending cardiologists. While many of these differences in perspective have existed in medical education for years, some appear to be due to specific generational differences between trainees and supervising physicians. Most current trainees in medicine are from the Millennial generation, and most attending physicians are either Baby Boomers or from Generation X.  Therefore, much has been made of how to communicate with Millennials.  We would like, however, to turn the tables and provide recommendations to Millennial trainees on how to interact with faculty. As millennial physicians, all three of us have observed attitudes and behaviors among ourselves, our colleagues, and our trainees that have caused conflict with supervising physicians and negatively impacted patient care. The purpose of this commentary is to provide millennial trainees with insight into their own generational tendencies and give recommendations on how to successfully navigate training in light of these tendencies.

The Millennial Generation, also known as Generation Y, refers to those born between 1982 and 2004(Howe and Strauss, 2000). We grew up in an environment in which our emotions were protected and our schedules were dictated largely by our “helicopter parents”(Epstein and Howe, 2006; Espinoza, Ukleja and Rusch, 2010). Frequently, our parents told us we were winners regardless of whether we had won anything. Many of the struggles of previous generations were absent from our childhoods, as were the growth and perspective that come from enduring hardship. As a result, we are often perceived as spoiled and entitled. We value social connectedness, teamwork, free expression, close relationships with authority figures, and work-life flexibility(Howell et al., 2009). On the basis of these generational characteristics, we make the following five recommendations for Millennials to successfully navigate medical training.

1. Get used to negative feedback

Many of us grew up being constantly told how great we were, and meaningful criticism was often withheld in an attempt to ensure our high self-esteem. As a result, we often derived our identity and value from positive feedback received from others. However, learning to practice medicine is difficult; mistakes will be made as a trainee and as an attending physician. It is the duty of supervising physicians to point out mistakes, both to trainees and to each other, as growth will only occur if we acknowledge and make changes in response to feedback. If we choose instead to focus on why we think the criticism is misguided or unfair, we miss out on this opportunity for growth. Growing through feedback requires letting go of the need to impress others, learning to be comfortable in our skin, and committing to pursuing what is best for our future patients.

2. Know that we are not as special as we think we are

Like most other Millennials, we have boxes of awards and trophies. Many were “earned” just for participation, and like most other physicians who possess the intelligence and work ethic to graduate medical school, some were awarded due to distinction from our peers. As a result, we sometimes falsely assume we are extraordinary, and that we deserve special treatment. However, in medical school and residency most of us find that we are now average in comparison to our peers, and even if we remain above average, we do not necessarily deserve special treatment. For many of us, a recalibration is in order as we recognize two things. First, we are all surrounded by many other intelligent, gifted physicians who are united with us in a common calling. Second, in a given day, the specific patient entrusted to our care is the one who is most worthy of special treatment.

3. Recognize that medicine is a calling, not a job

The term “calling” comes from the Latin vocationem, literally translated as “being called.” The term was first applied to one’s profession in the 1500’s, and the verbiage had spiritual overtones. One was directed by a higher power, or called, to a certain profession.  Whether or not we believe today that a higher power has called us to medicine, it still holds true that the demands of medicine involve extrinsic calls for help. Our patients figuratively and literally call on us, sometimes at odd hours, and often at their point of greatest need. To answer their calls requires diligence and commitment that are needed in few other professions.

4. Accept that many aspects of our lives are put on hold during training

Medical school and residency are unique seasons of life. During medical training, we have a short time to learn the practice of medicine with oversight before setting out on our own. Given this, many other interests and activities must be put on hold during training. Residency is not a 9 to 5 job, and as a result, we cannot have the lifestyles of many of our friends. This is not to say that every other aspect of one’s life is neglected during training. We (JD and EB) strove to prioritize our spouses and children through residency. However, to do this without neglecting our training, we had to put most of our hobbies, non-medical interests, and desired upper middle-class lifestyle on hold.

5. Don’t fully buy into the current culture of medicine

There is much to revere in a physician’s commitment to tireless work for the sake of the patient, regardless of the sacrifice. However, this mentality has likely contributed to the rise in physician burnout, which is currently afflicting greater than half of all physicians(Shanafelt et al., 2015). One of greatest contributions we as Millennials can offer to the profession of medicine is restoration of balance. While a huge part of our lives is tied to being physicians, it is not all of our lives nor is it arguably the most important part. We are not only physicians, but also spouses, children, parents, and friends. We need to cultivate these relationships and change the culture of medicine to foster balance. We must seek not only the health of our patients, but our own health as well. This will require us to lead in reforming the current medical education system that at times can rely on overwork and humiliation as a rite of passage and provides minimal formal training on emotional health, time management, financial competence, and self-care. 

Conclusion

A generational change among medical trainees is a reality, and both trainees and their supervisors need to face the challenges that it brings. We close with a reminder to us all. To practice medicine is a gift of incredible value, and we should treat it as such. We must remember that as we learn to care for those who are ill, one day we will be like sufferers and will similarly be in need of physicians who have devoted themselves to the practice of medicine with the same diligence and devotion with which we hopefully approached our own training.

Take Home Messages

Get used to negative feedback.

Know that we are not as special as we think we are.

Recognize that medicine is a calling, not a job.

Accept that many aspects of our lives are put on hold during training.

Don’t fully buy into the current culture of medicine.

Notes On Contributors

Asif Padiyath, MD is an anesthesia resident at John Hopkins Hospital.

Elijah Bolin, MD is an assistant professor of pediatrics and pediatric cardiologist at University of Arkansas for Medical Sciences and Arkansas Children's Hospital.

Joshua Daily, MD, MEd is an assistant professor of pediatrics and pediatric cardiologist at University of Arkansas for Medical Sciences and Arkansas Children's Hospital.

Acknowledgements

None.

Bibliography/References

Epstein, M. and Howe, P. (2006) 'The millennial generation: recruiting, retaining, and managing', Today’s CPA, Sept/Oct 2006, pp. 24–27.

Espinoza, C., Ukleja, M. and Rusch, C. (2010) Managing the Millennials: Discover the Core Competencies for Managing Today's Workforce. 1st edition edn. Hoboken, NJ: John Wiley & Sons.

Howe, N. and Strauss, W. (2000) Millennials Rising: The Next Great Generation. 3rd edn. New York: Vintage.

Howell, L. P., Joad, J. P., Callahan, E., Servis, G., et al. (2009) 'Generational forecasting in academic medicine: a unique method of planning for success in the next two decades', Acad Med, 84(8), pp. 985-93. https://doi.org/10.1097/ACM.0b013e3181acf408

Shanafelt, T. D., Hasan, O., Dyrbye, L. N., Sinsky, C., et al. (2015) 'Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014', Mayo Clin Proc, 90(12), pp. 1600-13. https://doi.org/10.1016/j.mayocp.2015.08.023

Appendices

None.

Declarations

There are no conflicts of interest.
This has been published under Creative Commons "CC BY-SA 4.0" (https://creativecommons.org/licenses/by-sa/4.0/)

Ethics Statement

Ethics approval is not required since this manuscript is a commentary.

External Funding

This article has not had any External Funding

Reviews

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BALAJI ARUMUGAM - (06/07/2019) Panel Member Icon
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This is an interesting paper in which the generations influence in medical training, a new aspect covered. I wondered about the idea and the concept derived by the authors in making this personal opinion paper.
The differences between Baby boomers, Gen X, Gen Y, Gen Z plays big role in all professions, but this was not touched so far in our medical profession. Good effort by the authors. As a medical teacher and medical educator belonging to the Gen X, finding it very difficult with the Gen Y (the millennials) co-workers and the Gen Z medical students to manage and guide them. A generational change among medical trainees is a reality, and both trainees and their supervisors need to face the challenges that it brings. As this paper speaks about the recommendations for the millennials, similar recommendations could have been done for the Gen X also.
Richard Hays - (01/07/2019) Panel Member Icon
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I found this an interesting paper, and the responses even more interesting! I think it was rather brave of some recent graduates to write about such a controversial topic, and to do this so politely and yet in a way that seems to have upset others in their generation more than others. Inter-generational disagreement is not uncommon. As Mike and the Mechanics sang in their song ‘The living years’, ‘Every generation blames the one before’. Yet how real is this? Yes, younger colleagues have some different views about priorities and work patterns, but I remember having quite different views to my seniors at a si liar time. I would like to defend and explain my understanding of the tip about not buying into the culture. I agree that wording could be different and also that the paper represents the views of perhaps a minority, but I worry about what workplace culture does to recent graduates. They may come in with different ideas, but the way health care is organised drives over-work, and possibly collusion that sees things go on in much the same way as before. Altered work-life balance is better in theory than the practicality of the lower income that may come with it. Recent graduates are not the only ones to think that they may be special, only to discover that they are surrounded by lots of special people, particularly their patients and colleagues. The paper is therefore a great piece of provocation for us all to think about how to nurture professionalism, and in particular the profession that will care for us as we age and become frail. Some research might be a sound idea to unpack the complexity of these issues.
Possible Conflict of Interest:

For transparency I am the Editor of MedEdPublish

Alexander Woywodt - (28/06/2019)
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Padiyath and colleagues write on the interesting topic of Millennials in medical training. I have to confess I am not entirely sure about the audience of this manuscript. While the topic is intriguing the text does not convince me nor do I find the recommendations particularly interesting. Much of the text feels very generic and lacks concrete thought or suggestions for improvement. For example when the authors conclude that “aspects of our lives are put on hold during training“ – I find it difficult to see this statement as anything else but a platitude. Some of their statements I also find quite contradictory – at one point the authors recommend that Millennials should see medicine as a calling while further down they claim that what their generation can give to the world of medicine is a healthier work life balance. Personally I think the authors can’t have it both ways. Their statement that “This will require us to lead in reforming the current medical education system that at times can rely on overwork and humiliation as a rite of passage” seems a little naïve to me. Workload issues in medicine are multifactorial and are not only caused by culture and a tradition of over-working trainees (as the authors seem to imply) but also by an imbalance between increasing numbers of elderly and multi-morbid patients and constrained resources. In summary I find this manuscript disappointing, all the more so because the topic is really interesting and probably highly relevant. In fact the topic came up in several educational meetings and workshops I have attended recently. I am not sure an opinion piece was the right article format either for this topic and I agree with others that a few positive and constructive thoughts would be welcome in this article. I think an overview of generational differences in terms of learning preferences, attitudes and behaviors and practical consequences and ideas for medical education would have been so much more worthwhile
Julie Williamson - (28/06/2019) Panel Member Icon
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The authors offer five relatively brief tips for millennial medical students to assist them as they navigate medical training. Although I think the authors may be genuine in their desire to offer assistance to others in their generation, the advice delivered is too general and brief to be helpful (e.g "we are not as special as we think we are") and risks further entrenching readers in generational stereotypes that over simplify the complex dynamics that exist in each individual's personality. I think this article could've been improved by additional research and discussion of how millennials interact with members of each of the other generations mentioned (generation X, baby boomers), highlighting specific common areas of conflict with each generation separately, and offering more specific and practical workplace-based tips for communicating and interacting inter-generationally.
Possible Conflict of Interest:

For Transparency: I am an Associate Editor of MedEdPublish.

Bonnie Taylor - (27/06/2019)
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As the parent of a young person fitting the intended readership's demographic and a medical education professional associated with undergraduate medical education in the U.S., I read this paper with interest and was intrigued by the approach, a "flipped" perspective on a question that permeates discussions at medical education conferences. I urge the authors to consider who their actual audience might be, and propose that it is not their peers. The potential audience investigating this topic would likely be medical educators looking for nascent/recent investigation, and perhaps source material to offer students to support their efforts toward success in medical school. Perhaps consider what would happen if a pre-clerkship or bedside teacher were to distribute this work as a source for advice. I concur with another reviewer that the overall tone and perpetuation of a common narrative is not particularly productive in that context. While there is authenticity in the perspective (since it is written by recent students for current students), the outlook appears to this Baby Boomer to be unnecessarily judgmental.

However, considering that it seems to me that the motive is to provide a real-world perspective in the spirit of helpfulness, I believe a bit of reworking to make the paper more scholarly would be helpful in advancing the dialog about intergenerational communication and interaction. Specifically, I urge the authors to consider reworking the paper to become more of an evidence based position paper than a commentary with references. One way to accomplish this would be to advance the discussion by considering how a millennial's outlook might itself affect academic medicine in the context of patient safety or quality of care -- using actual evidence from peer-reviewed research OUTSIDE medicine and academic medicine. Perhaps consider providing evidence of exhibited behaviors supporting or undermining the stereotypes associated with the population in question, and the impact those behaviors have in professional identity formation. Using such a framework, the paper could offer a deeper level of advice than what might be interpreted as "get over yourself" or "welcome to adulting."

Overall, I am optimistic about the authors' potential to contribute substantively to the body of knowledge about this topic if approached with a measure of scholarly rigor. They bring a fresh perspective and have evidently reflected personally on the importance of addressing the topic for themselves and their peers.
Renee LeClair - (27/06/2019)
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Thank you for your reflection of millennials, and as fellow millennial and Medical school educator, I feel strongly your generational conversation fails to address a clear learning opportunity between generations. Too often, the conversations focuses on how millennial's need to change, 'buck up" (Know that we are not as special as we think we are.) and this article feeds into this negative mentality.

If we want to change major issues, such as physician burn out (as you noted), cultures of critical feedback and acceptance of diversity, we need to approach the generational issue from a fresh perspective (vs. historic norms.)

Your points are generally negative, overly conflicting and misguided.

1. Know that we are not as special as we think we are. Self-worth can be overly inflated across all generations and is not limited to millennials but is displayed differently. For example, this perspective of millennials stems from traditionalist view points who largely view that respect comes from years in service. Millennials who are inquisitive, questioning of 'elders' are then perceived as less resilient or disrespectful. Perhaps the teachable moment here is communication and cross generation respect. Learning is not purely vertical. The education provided to current medical student is different than that experienced by Attendings, Section chiefs and chairs. I encourage them to embrace this difference, students are excellent sources of modern information.

2 &3 Recognize that medicine is a calling, not a job. and Accept that many aspects of our lives are put on hold during training. These are categorically discordant with your last point. How can we expect change in physician culture when you are asking students to put life on 'hold'. This unrealistic attitude stemming from conversations that often start with 'when I was in school' need to end. If we want students to - 'not fully buy into the current culture' then we need to allow them to this latitude without labeling them as lackluster. However, based on this reflection, if students are not buying into the culture - they are by definition perceiving themselves as overly special. Having considerable interests outside of a profession is healthy and should not be considered weakness.

3. Don’t fully buy into the current culture of medicine. See above, this is not largely possibile if you are articulating to students to put life on hold, work as if it were your life were nothing beyond your profession.

Generally this article perpetuates the negative connotations of generation differences and offers no advice that will generate tractable, positive change in the physician work force. The larger conversation should focus more on embracing the diversity these students bring to the table as opposed to stifling alternative perspectives. If change is truly what is wanted to address health care issues, then we should welcome these new perspectives rather than asking younger generations to buck up.

Please consider advocating for your student - physician peers a new generation is coming and I am excited to learn from them. You should be too.